Early quality of life assessment in men treated with permanent source interstitial brachytherapy for clinically localized prostate cancer

Purpose: We prospectively assessed quality of life changes with time using validated instruments in men with clinically localized prostate cancer trea ted with permanent source interstitial brachytherapy. Materials and Methods: A total of 46 men consecutively treated with permane nt source interstitial brachytherapy between September 1997 and June 1998 c ompleted quality of life (Functional Assessment of Cancer Therapy-Prostate [FACT-P]) and urinary symptom (International Prostate Symptom Score [I-PSS] ) questionnaires before (T0), and 1 (T1) and 3 (T3) months after treatment. All participants were treated with (125)iodine alone. Repeated measures an alyses of variance were conducted on all quality of life and urinary outcom e measures for 44 patients with data at all 3 time points. Results: Median patient age was 68 years (range 51 to 80). All men had clin ical T1c to T2b prostate cancer, Gleason score was 6 or less in 36 (78%) an d median pretreatment prostate specific antigen was 7 ng./ml. (range 1.1 to 20.6). Mean score (and standard deviation) at T0, T1 and T3 for each quest ionnaire was FACT-P 138.9 (14.4), 128.6 (19.4) and 136.7 (17,4), T0 versus T1 p = 0.0005 and TO versus T3 p = 0.6612, and I-PSS 8.3 (5.4), 19.7 (9.0) and 15.7 (7.2), TO versus T1 p = 0.0001 and TO versus T3 p = 0.0001. For th e global test across time statistically significant differences were observ ed for the cumulative scores of PACT-P, I-PSS, physical well-being and pros tate cancer subscales of the FACT-P and the Trial Outcome Index. By 3 month s all quality of life measures had returned to baseline. Urinary symptoms a s measured by I-PSS persisted for at least 3 months. Conclusions: Clinically meaningful decreases in quality of life, as measure d by the FACT-P instrument, were evident within weeks after permanent sourc e interstitial brachytherapy. However, by 3 months FACT-P scores returned t o near baseline levels. A validated instrument designed to measure urinary symptoms (I-PSS) demonstrated that moderate to severe urinary symptoms pers isted for at least 3 months following permanent source interstitial brachyt herapy. An instrument specifically designed to measure urinary symptoms can provide additional clinical information when combined with FACT-P.